37D2042409 CLIA NUMBER - FRESENIUS KIDNEY CARE BRISTOW, LLC

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Laboratory Demographics

CLIA Number: 37D2042409

Facility Name: FRESENIUS KIDNEY CARE BRISTOW, LLC

Facility Address:
402 SOUTH MAIN STREET
BRISTOW, OK
ZIP 74010
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Facility Phone Number: 918 771-4093

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1164943833

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2042409
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS KIDNEY CARE BRISTOW, LLC
Street	402 SOUTH MAIN STREET
City	BRISTOW
State	OK
ZIP	74010
Phone	918 771-4093
CertificateType	4
CertificateEffectiveDate	6/13/2022
CertificateExpirationDate	6/12/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024